chapter 4 : patient care: nursing

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 4: Patient Care: NursingChapter 4: Patient Care: Nursing


Registered NursesRegistered Nurses

• Overview

– Most education & widest scope of practice of nurses

– Largest health care occupation in U.S.

– Large demand

– Diverse work settings

– Flexible working arrangements

– U.S. News & World Report: one of the best careers of 2010


Registered Nurses (cont’d)Registered Nurses (cont’d)

• History of the Profession– Ancient times: women tending families during sickness

– Early Christian times: deaconesses & religious orders provided care

– Early 16th century: criminals served as nurses in lieu of jail time

– 18th & 19th centuries: reform in roles

– Florence Nightingale: elevated nursing to respected profession

– After WWII: universities & colleges set up schools of nursing

– States developed & adopted a national licensing exam for nurses



Florence Nightingale, Clara Barton, Isabel Hampton Robb, & Mary Mahoney (Courtesy of the Center for the Study of the History of Nursing, University of Pennsylvania)



• Diploma Programs

– Offered by hospitals

– 3 years to complete

– Earliest of nursing programs

– Main source of graduates until 1960s

– Decreasing in number in recent years

– Emphasis on clinical experience in direct patient care



• Associate’s Degree Programs– Associate’s degree in nursing (ADN)

– Offered at community or junior colleges

– Typically 2-3 years

– Prepare nurses for various settings

• Hospitals

• Long-term care facilities

• Home health care

– Provide technical skills

– Prepare students to carry out nursing roles & functions



• Bachelor’s Degree Programs

– Bachelor of science in nursing (BSN)

– 4 years to complete

– Accelerated BSN programs for those who already have bachelor’s

– Built on general education base

– Concentration on nursing at upper levels

– Emphasis on working with health care team, research, foundation for graduate study, variety of practice settings



• Course Work

– Anatomy

– Physiology

– Microbiology

– Chemistry

– Nutrition

– Psychology

– Nursing practice



• Further Education– Bachelor’s degree

• RN-to-BSN bridge program

• Required for many administrative, managerial, & community health positions

• Accelerated master’s degree programs (combined BSN & MSN)

– Master’s degree programs

• Required for all advanced practice nurse specialties

– Doctoral degree programs

– In-service education (on-site training)



• Licensure

– NCLEX-RN: licensing exam for RNs

– Exam & licensure is by states

– Nurse practice acts: regulation of nursing by states

– License renewal required



• Certification– Specialty certification available

– Leads to higher pay

– American Association of Critical-Care Nurses (AACN)

– American Nurses Association (ANA)

– Requires:

• Licensure

• Bachelor’s degree or graduate degree or work experience

– Must be renewed every 3 (AACN) or 5 (ANA) years



• General Duties

– Care & treatment of patients

– Supervision of other nurses & nursing assistants

– Protection of patient rights

– Advice & emotional support to families of patients

– Communication with other health care professionals

– Patient education



• Specialties– Emergency or trauma care

– Critical care

– Addiction

– Diabetes

– Specific organs & body systems (e.g., cardiovascular)

– Specific population (neonatal, pediatric, geriatric)

– Advanced practice

– Non-patient (infection control, forensics, informatics, case management)



• Personal Characteristics

– Desire to help others

– Caring, sympathetic attitude

– Detail-oriented

– Flexible

– Good judgment

– Responsible

– Team work



• Employment Opportunities and Trends

– 32% growth from 2008 to 2018

– In demand due to:

• Improvements in medical technology

• Increased emphasis on preventive care

• Growth in number of older adults



• Professional Organization– ANA

– Formed from state nurses’ associations

– Founded in 1896

– Sets standards of practice

– Encourages research to advance nursing practice

– Advocates on behalf of nursing at state & federal levels

– Benefits: subscription to journals, discounts on certification, online continuing education, conferences, educational events


Licensed Practical NursesLicensed Practical Nurses

• History of the Profession– 1892: first formal training program in U.S., at YWCA

– 1930: 11 practical nursing schools were operating

– Late 1930s: process of state licensure begun

– Expansion after WWII due to shortage of RNs & other factors

– 1941: Association of Practical Nurse Schools founded

– Renamed National Association for Practical Nurse Education and Service (NAPNES)

– 1955: All states had licensure laws

– 1966: Accreditation of schools by National League for Nursing begun


Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)

• Education

– Training in bedside nursing care

– Programs offered by:

• Technical & vocational schools

• Community/junior colleges

– Programs require HS diploma or equivalent

– Last about 1 year

– Classroom study & supervised clinical practice



• Course Work– Basic nursing concepts

– Anatomy & physiology

– Medical-surgical nursing

– Pediatric nursing

– Obstetric nursing

– Pharmacology

– Nutrition

– First aid



• Professional Certification

– Licensure required in all states

– Requires:

• Graduation from state-approved program

• Passing the NCLEX-PN



• Work Responsibilities

– Hands-on tasks

– Basic nursing care

– Collect lab samples

– Perform routine tests

– Assist physicians & RNs in administering tests

– Monitoring

– Cleaning medical equipment




– Empathetic

– Emotionally steady

– Observant

– Good communication skills

– Patient

– Able to follow orders & work under supervision




– Growing occupation: 21% between 2008 & 2018

– Best opportunities in:

• Home health care

• Nursing care facilities



• Professional Organization– NAPNES

• Founded by LPNs

• Develops practice & education standards for LPNs

• Represents LPNs in national meetings

– National Federation of Licensed Practical Nurses (NFLPN)

• Governed completely by LPNs

• Promotes high standards of education & practice

• Monitors legislation

• Represents LPNs before Congress


Certified Nursing AssistantsCertified Nursing Assistants

• Overview

– Perform simple, basic nursing functions

– Provide care of patients’ personal needs

– Are under direction of LPN or RN


Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)

• History of the Profession

– Delegation of nursing tasks to auxiliary personnel after WWII

– Assistants began to take over tasks of student nurses

– Assistants began working in long-term care facilities & hospitals

– 1980s: U.S. Institute of Medicine recommended formal training

– 1987: Law passed requiring all states to set up training programs



• Education– Required for certification:

• Completion of state-approved training program

• Passing a competency test

– Training programs

• Minimum of 75 hours

• Available at vocational schools, community colleges, Red cross, health care facilities

– Recertification requires at least 12 hours of in-service education each year



• Course Work

– Anatomy & physiology

– Bathing, dressing, & other personal care skills

– Nutrition

– Safety & emergency procedures

– Communication skills

– Documentation skills

– Infection control

– Patient room upkeep

– Patient/resident rights



• Work Responsibilities

– Hands-on, personal patient care

– Assist with personal hygiene

– Serve meals

– Help patients eat & dress

– Transport patients

– Answer patient calls

– Take vital signs

– Assist other medical staff




– Empathy

– Patience

– Emotional strength

– Cooperation

– Respect

– Professionalism

– Responsibility




– Part of a category called nursing aides, orderlies, & attendants

– 19% growth between 2008 & 2018

– Growth is due to:

• Aging of population & need for long-term care

• Early discharges of patients from hospitals

• Life-extending technologies



• Professional Organization

– National Association of Health Care Assistants

– Provides development training & mentoring programs

– Advocates on issues related to caregivers & long-term care

– Membership benefits

• Educational opportunities

• A news magazine

• A national convention

• A national awards program

chapter 4 : patient care: nursing

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